Intellectual disability in children with attention deficit hyperactivity disorder

Abstract

Objective: To determine whether children with attention deficit hyperactivity disorder (ADHD) and mild intellectual disability (ID) are a clinically distinct ADHD subgroup.

Study design: This was a cross-sectional study comparing clinical characteristics (ADHD subtypes, total number of symptoms, and rates of common comorbidities) between children with ADHD and mild ID and those with ADHD and IQ test scores >70, and also between children with ADHD and ID and a general population sample of children with ID alone. The sample comprised a clinical sample of children with ADHD with ID (n = 97) and without ID (n = 874) and a general population sample of children with ID and without ADHD (n = 58).

Results: After correcting for multiple statistical tests, no differences were found between the 2 ADHD groups on any measure except the presence of conduct disorder (CD) symptoms and diagnoses. Children with ADHD and ID had higher rates of both (OR, 2.38; 95% CI, 1.71-3.32 and OR, 2.69; 95% CI, 1.69-4.28, respectively). Furthermore, children with ADHD and ID had significantly higher rates of oppositional defiant disorder (OR, 5.54; 95% CI, 2.86-10.75) and CD (OR, 13.66; 95% CI, 3.25-57.42) symptoms and a higher incidence of oppositional defiant disorder diagnoses (OR, 30.99; 95% CI, 6.38-150.39) compared with children with ID without ADHD.

Conclusion: Children with ADHD and mild ID appear to be clinically typical of children with ADHD except for more conduct problems. This finding has implications for clinicians treating these children in terms of acknowledging the presence and impact of ADHD symptoms above and beyond ID and dealing with a comorbid CD.

Keywords: ADHD; ALSPAC; ASD; Attention deficit hyperactivity disorder; Autism spectrum disorder; Avon Longitudinal Study of Parents and Children; CAPA; CD; CNV; Child and Adolescent Psychiatry Assessment; Conduct disorder; Copy number variant; DSM-III-R; DSM-IV; Diagnostic and Statistical Manual of Mental Disorders, 3rd edition revised; Diagnostic and Statistical Manual of Mental Disorders, 4th edition; ID; Intellectual disability; ODD; Oppositional defiant disorder.